It was breast cancer.

Debbie Horwitz was 32.

She chose to remove both breasts, a double mastectomy, even though the doctor said he could scoop out the lump. When Debbie was 9, her mother died of breast cancer. Her grandmother had it, too. Newly engaged, she would not flirt with chance.

Like most women who have mastectomies, she was determined to rebuild her body, to reclaim her curves. She would reconstruct her breasts and slip, princesslike, into her mother's retooled wedding dress with its clingy, creamy silk bodice.

She couldn't believe it when the plastic surgeon told her there were no pictures of what women her age could expect from the process. The pictures would show women in their 60s and 70s, who are far more likely to get breast cancer. Young women have more elasticity in their skin, he told her. Her results would be completely different.

A friend tried to take her mind off the tumult. Before the mastectomy, she booked Horwitz an appointment to have her engagement portrait taken.

She figured Horwitz, a child advocacy specialist with the N.C. Department of Administration, could primp and pose and feel pretty in the midst of her despair.

The timing was also practical. Horwitz knew that chemotherapy would steal her hair; at least she could sit for pictures before it fell out.

She met her photographer, Missy McLamb, at the Raleigh Rose Garden on a simmering June morning in 2004. The thorny bushes wore voluptuous, velvety blooms. Horwitz wore a green and white tube top, the kind that accentuates the chest. McLamb took note of that.

As McLamb snapped the shutter, Horwitz shared her story. Afterward, in the parking lot, McLamb made a casual offer: If you want, if you think it would help you heal, I can chronicle the process.

Horwitz's face revealed nothing, but she thought it was an outrageous suggestion. No way could she stand topless in front of a camera. That night, she told Evan, her fiance, about it. Isn't that weird?

But she couldn't stop considering the possibilities. You know, she told him, pictures don't exist. Maybe it could help other women like me.

OK, she told McLamb. Let's do it.

A week later, on June 27, Horwitz finally let herself weep for what was and what was about to be.

The next morning, a doctor sheared Horwitz's breasts from her chest.

Horwitz felt the blow at the core of her femininity, and she was scared. She was desperate to know how she would look each step of the way as a surgeon sculpted breasts where only flaps of pearly scar tissue remained. These new breasts would literally recast her body image. She'd need new bras, new tops to conform to her unfamiliar silhouette. But she had no idea what that would look like.

A tough first shoot

Her body would get a few months to heal before a surgeon would begin the type of reconstruction Horwitz chose -- delayed tissue expansion. Tissue expanders -- Horwitz calls them water balloons -- would be inserted beneath the skin and slowly inflated over many weeks, her skin stretching painfully to accommodate them. A nipple would be fashioned, then tattooed with pigment.

But first, as planned, McLamb showed up at Horwitz's North Raleigh home in August to take the first picture. McLamb doesn't do well with gore. She was nervous about how she'd cope with Horwitz's body, still etched pink with fresh scars.

McLamb walked through the door and heard Horwitz shout: Tell her to go away!

Horwitz's stepmother apologized to McLamb. She's just not strong enough, she said.

As McLamb turned to leave, Horwitz raced down the stairs.

"Stay," she pleaded. "I don't want to do this. But I have to do this."

They settled on the dining room for a backdrop. The long windows yielded dreamy, diffuse light.

After 10 years documenting weddings, McLamb knows how a woman should stand to look her loveliest -- shoulders turned toward the camera, hips away, arms a little out from the body. This was no different.

And yet it was.

Horwitz unbuttoned her shirt, revealing a chest flat as a young child's. Three-inch-long scars carved twin swaths diagonally from where Horwitz's breasts used to be toward her armpits. Horwitz felt ugly and self-conscious. McLamb felt sick. But she grabbed the 1950s-era Rolleiflex she'd chosen for its artsy feel and started shooting. She steadied herself by focusing on the lighting, the composition, the exposure.

The first photo shoot was the most difficult. It was awkward and tentative and hard to make conversation.

Gradually, the sessions grew more relaxed. As Horwitz's new breasts began to take shape, McLamb would compliment her. They're so perky, she'd say, and they'd laugh.

The unsettling truth

But Horwitz shuddered at how the photos captured the weight she'd put on from the drugs she took to stave off nausea during chemotherapy. She had cautioned McLamb against showing her face, but her belly was flabby, her waist undefined. She wanted the images retouched.

You can't, McLamb said. It wouldn't be truthful.

The photos, taken from the neck down, tell a black-and-white tale of loss and renewal. McLamb thinks they're beautiful, but not in the manner of a perfectly composed shot of the sun setting.

It's Horwitz's freckled chest, her scar tissue, her brand-new breasts with their surgically refined swells in the photos. But it's hard to see them and not think of your girlfriend, your wife, your sister -- yourself. It is hard to look at them but also hard to look away.

One day, Horwitz told McLamb she wanted the photos to be more than a personal documentary. She wanted others to see them, women like her losing the essence of womanhood just as they were dating, getting married, starting families.

She decided to make knowledge her crusade. She went online and learned that pamphlets like the one she envisioned existed in other states. As far as she could tell, there was nothing like them in the Triangle. She appealed to the Triangle affiliate of the Susan G. Komen Breast Cancer Foundation, which awarded her a grant to share the photos and, through them, her story with other young women.

What has emerged are 6-by-6-inch booklets featuring step-by-step photos of the reconstruction and explanatory text. They are dedicated to her mother. It's up to Horwitz to find homes for them, so she has begun calling patient representatives at local hospitals and doctors' offices. Monday, she has arranged to leave the first batch at the Rex Cancer Center.

She has also ventured into cyberspace, where come summertime she will post a virtual version of the booklet. "This is your life," reads a message on the home page of www.myselftogetheragain.org. "This is your body. Don't let this disease take it from you."

Horwitz has never been particularly modest. But online, she thought privacy might be a good idea, so the breasts in the pictures will belong to "Denise."

Here, in a community where she was diagnosed, treated and made whole again, Debbie Horwitz is not afraid to claim them for her own.

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